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    Neurotoxin (Botox / Dysport) for wrinkle treatment and prevention

    Botulinum toxin, or neurotoxins, are injectable products utilized for improvement and prevention of facial wrinkles, amongst other medical uses. Botox® and Dysport® are the commercial names of the most popular brands of neurotoxins used for cosmetic purposes.

    How does Botox / Dysport work?

    Neurotoxins work by relaxing the muscles of facial expression, softening facial wrinkles and deep creases. We inject the product with tiny needles under the skin and into the facial muscles for the treatment of the lines/wrinkles that appear when we make certain facial expressions such as frowning (the “elevens” in the middle of the eyebrows) or the “crow’s feet” on the lateral face upon smiling.

    Which areas can be treated with Botox / Dysport?

    We can treat any areas of the face with deep lines or strong facial expressions caused by intense activity of the facial muscles, such as:

    • Forehead lines
    • Crow’s feet
    • Chin dimpling
    • Neck (platysma) bands
    • Perioral lines
    • “Bunny lines” on the sides of the nose
    • Gummy smile
    • Droopy brows


    Neurotoxin injections take just a few minutes and there is no downtime after the procedure.
    Dr Gabriele C Miotto, Aesthetic Plastic Surgeon in Atlanta.


    How is the downtime after neurotoxin injections?

    The injection takes just a few minutes and there is no downtime. Patients can go back to work right away. It is not common to have bruising or swelling after botulinum toxin treatment, but small bruising can happen and is easily hidden with makeup. It takes about five to seven days for the effect to “quick in” and the full results are seen at about ten days after the treatment, once the muscles are completely relaxed. Typically, we recommend avoiding intense exercise the same day of the injections, but you can expect to get back to your normal activities the next day.

    How long do Botox injections last?

    Injections last for three to five months on average, but sometimes up to six months depending on how strong the facial expressions are, how hydrated the skin is, and on the amount of units used in the treatment session. As we keep aging, botulinum toxin injections are a great tool to maintain a youthful facial skin and prevent deep lines and creases.

    I am a good candidate for Botox / Dysport?

    If you notice wrinkles on your forehead, around the eyes, chin dimpling or neck bands, you may be a good candidate for botulinum toxin. It can also be used to create a light brow lift and reshaping of the brow. If you have neck bands (platysma bands), Botox injections can give you a soft neck lift and better definition in the jawline. An in-person consultation is important to define your goals and expectations, number of units needed, effect on brow shape and brow lift, and overall improvement of your facial expression. It will be a pleasure to see you for a consultation and choose the best treatment for you.

    GABRIELE C. MIOTTO MD, MEd., is a Brazillian-American plastic surgeon specialized in aesthetic surgery and minimally invasive aesthetic procedures such as facial injectables. She is known and recognized for her beautiful and natural results. Call or email our office to schedule your appointment!

    Preparing for facial injections and avoiding unwanted bruising:

    1. DO NOT take any aspirin for 7-10 days before your scheduled procedure. Please contact the office if you are prescribed aspirin by your cardiologist or Primary Care Provider (PCP). Do not take NSAIDS (Aleve, Motrin, Ibuprofen) for 5 days before injections. You may take Tylenol (Acetaminophen) if needed for aches or pains.
    2. Discontinue Vitamin E 7 days before injections.
    3. Avoid the following herbal supplements for7 days before your injections: Echinacea, Ephedra / Phentermine (used for weight loss), Feverfew, Fish Oils, Garlic, Ginkgo Biloba, Goldenseal, Kava-Kava, Licorice, Saw Palmetto, St. John’s Wort and Valerian.
    4. Stop Smoking. The harmful effects of smoking cause a lot of wrinkles…and those are not well treated with botulinum toxin!
    5. Alcohol can promote bleeding so it is best to avoid alcohol intake for at least a few days before the injections.
    6. Start oral anti-bruising supplements with Arnica Montana / Bromelian the day before your injections and continue for 3-5 days after the injections.

    Atlanta Botox Specialist

    Some signs of aging that develop on the face result from reoccurring muscle contractions. These signs include crow’s feet, which are the lines at the outer corners of the eyes, moderate to severe lines on the forehead and the vertical lines (11s) that develop between the eyebrows. Atlanta plastic surgeon and expert injector Dr. Gabriele Miotto uses the purified neurotoxin protein (aka neuromodulator) BOTOX® Cosmetic to temporarily relax these muscles. By temporarily restricting the movement of the facial muscles responsible for creating lines and wrinkles, the patient’s face appears more youthful. Purified neurotoxin protein injections offer patients a way to recapture their youth quickly, with minimal pain and zero downtime.

    Who May Be Good Candidates for BOTOX Cosmetic Injections in Atlanta?

    Healthy men who are at least 18 years old with realistic expectations about the results neuromodulator injections can provide. Healthy women who are at least 18 and not currently pregnant with realistic expectations about the results neuromodulator injections can provide.

    Is BOTOX Cosmetic Approved For Use By the FDA?

    Yes, the FDA approves the use of BOTOX Cosmetic for addressing the signs of aging that result from muscle contractions in individuals who are at least 18 years of age.

    Who Should Consider Neuromodulator Injections at ME Plastic Surgery in Atlanta?

    Men and women who have crow’s feet, 11s and severe to moderate lines on their forehead that they would like to eliminate should schedule an appointment with Dr. Gabriele Miotto. By addressing muscle-induced facial wrinkles (aka dynamic wrinkles), with neuromodulator injections, Dr. Miotto makes it possible for these areas to become smoother, which makes the patient appear more youthful.

    Other issues that Dr. Gabriele Miotto addresses with purified neurotoxin protein injections include:

    • Droopy eyebrows.
    • Horizontal forehead lines.
    • A downturned mouth.
    • Marionette lines.
    • Bunny lines.
    • Perioral lines.
    • Small bags beneath the eyes.
    • A thin upper lip.
    • A gummy smile resulting from hyperactive lip muscles.
    • Chin dimples.
    • Horizontal neck lines.
    • Vertical platysma bands.

    Certain Facial Movements Cause Muscle-Induced Wrinkles to Appear More Prominent

    There are facial actions that cause muscle-induced wrinkles to become more noticeable. These actions include squinting, frowning, smiling, laughing and habitual facial expressions.

    How Do Neuromodulators Work?

    BOTOX Cosmetic consists of a solution that contains botulinum toxin type A. In small doses, botulinum toxin type A acts like a muscle relaxer, essentially freezing the muscles to keep them from moving. Botulinum toxin type A accomplishes this by blocking the nerve endings that are transporting the signal from the brain telling the muscle to contract. By blocking these signals, the muscle contractions cease.

    What is Botulinum Toxin Type A?

    Botulinum toxin type A derives from the bacterium clostridium botulinum, which is found in lakes, forests and soils all over the world. In addition, shellfish, fish and mammals can carry clostridium botulinum. Under normal circumstances the spores of the clostridium botulinum bacterium itself are, for the most part, harmless. Nonetheless, if these spores are subjected to a low-oxygen setting they germinate, grow and release seven different toxins, including botulinum toxin type A.

    Can BOTOX Cosmetic Address Facial Lines Not Resulting from Muscle Contractions?

    No, neuromodulators are ineffective for addressing wrinkles resulting from anything other than muscle contractions. However, Dr. Gabriele Miotto uses dermal fillers to address other facial lines and wrinkles resulting from the natural aging process, sagging skin and sun damage.

    How Long Does It Take to See the Results After a Purified Neurotoxin Protein Injection Treatment?

    Following a neuromodulator injection treatment in Atlanta, results are not visible immediately because it can take up to five days for a patient’s muscles to fully relax.

    How Long Will the Results of a BOTOX treatment in Atlanta Last?

    The results of a neuromodulator injection treatment at ME Plastic Surgery in Atlanta can last up to six months.

    What Are the Differences Between BOTOX Cosmetic and Dysport?

    All three of these neuromodulators are approved by the FDA for the treatment of facial lines and wrinkles resulting from muscle contractions.

    Dysport spreads farther away from their injection point than BOTOX does.

    When compared to the depth of a BOTOX injection, the expert injector administers Dysport injections deeper into the skin.

    Dysport results tend to appear a day or two sooner than the results of a BOTOX treatment.

    After an Individual Has Neuromodulator Injections, Is It Obvious to Others?

    As long as an experienced expert injector administers the neuromodulator, the results should be subtle and look completely natural. Many times, family members and friends comment about how rested and refreshed the individual looks. Nonetheless, they will only know about the treatment if the patient decides to inform them about it.

    Areas Frequently Treated with BOTOX in Atlanta

    Men and women in and around Atlanta receive neuromodulator injections from Dr. Miotto to address the signs of aging. After their purified neurotoxin protein treatment, patients enjoy a more refreshed, youthful-looking appearance. As a plastic surgeon and expert injector, Dr. Gabriele Miotto can also use targeted neuromodulator injections to address neck, jawline and chin issues.

    Neuromodulator treatment areas include:

    The Eyebrows — A Brow Lift

    Using BOTOX injections, Dr. Miotto relaxes the muscles causing the ends of the eyebrows to fall, which provides a lifting effect. Once the muscles are no longer pulling the eyebrows downward, the patient’s eyes open wider, making the individual appear well rested and refreshed. In addition, after a brow lift, the patient’s eyebrow arches have a more pleasing appearance.

    The Vertical Lines Located Between the Eyebrows — The Glabella Lines

    Glabella lines (aka frown lines, 11s, furrowed brow) is one of the terms referring to the vertical creases between the eyebrows. Once the brow becomes furrowed, an individual looks as if he or she is angry or tired all the time.

    Dr. Miotto addresses these lines by injecting BOTOX into the glabella muscle. When a patient has deep-set frown lines between the eyebrows, Dr. Miotto may recommend that the patient have a combination injection treatment.

    During a combination glabella line treatment, Dr. Gabriele Miotto uses a dermal filler to fill in the deeper area and then uses a neuromodulator to relax the glabella muscle. This combination treatment is highly effective for individuals who have deep glabella lines.

    The Forehead — Forehead Lines

    The frontalis muscle is the muscle in the forehead that is responsible for lifting the eyebrows. Upon raising the brow, there are horizontal lines that become visible. These horizontal lines run from one side of the forehead to the other. Once the individual lowers his or her brow, these lines usually disappear. However, people who frequently raise their eyebrows may have visible lines across their forehead even while their frontalis muscle is at rest.

    At ME Plastic Surgery in Atlanta, expert injector Dr. Gabriele Miotto uses BOTOX injections to relax the patient’s frontalis muscle. The goal of injecting purified neurotoxin protein into the frontalis muscle is to relax the muscle and prevent deepening of these lines. Many times, after a treatment with BOTOX, these lines disappear completely.

    The Outer Corner of the Eye — Crow’s Feet

    The term Crow’s feet refers to the fine lines that develop at the outer corners of the eyes. Dr. Miotto injects purified neurotoxin protein into the lateral orbital lines. Within five days of these injections, the targeted muscles fully relax. At which point the patient has more youthful-looking eyes.

    A Downturned Mouth Resulting in a Habitual Frown

    The depressor anguli oris (aka triangularis) muscle is a paired triangular-shaped muscle that is associated with frowning. This muscle originates in the lower jaw (aka the mandible) and continues upward to the outside corners of the mouth, ending at the orbicularis oris muscle. The orbicularis oris muscle is the ring-like muscle that encompasses the entire mouth.

    Some individuals carry tension in the muscles around the mouth. This continued tension may cause the depressor anguli oris muscle to pull the corners of the mouth downward. When this happens, the individual has a continuous frown.

    To eliminate this perpetual frown, plastic surgeon and expert injector Dr. Gabriele Miotto injects Botox Cosmetic into the patient’s depressor anguli oris muscle.

    The Lines Running Downward from the Outer Corners of the Mouth to the Chin — Marionette Lines

    Since marionette lines run downward and look droopy, they can also cause an individual to look unhappy or sad all the time.

    Just as with a perpetual frown, Dr. Miotto injects a purified neurotoxin protein into the triangularis muscle to soften these lines. Within five days of his or her injections, the patient enjoys a more youthful-looking mouth and lower face. Once this muscle relaxes, the patient can visually express his or her happiness.

    The Diagonal Lines That Extend from the Bridge of the Nose Toward the Inner Corner of the Eye — Bunny Lines

    Bunny lines refer to the straight, diagonal lines that extend from the top of each side of the bridge of the nose toward the inner corner of the corresponding eye. Since these lines tend to resemble rabbit ears, their nickname is bunny lines.

    Bunny lines usually become visible while smiling or laughing. However, with age, these lines may be visible all the time.

    Dr. Miotto greatly decreases the visibility of bunny lines by strategically injecting a purified neurotoxin protein into the transverse nasal muscles on each side of the patient’s upper nose.

    The Perioral Lines — Smoker’s Lines

    The perioral lines are the vertical lines that develop around the lips. As part of the natural aging process, this area around the mouth is one of the first places that wrinkles develop. These lines may be extremely fine or deep. Dr. Miotto addresses these lines by injecting BOTOX into the orbicularis oris muscle. This muscle looks like a ring and encompasses the entire mouth. Once the orbicularis oris muscle completely relaxes (which can take up to five days), the smoothness around the patient’s mouth makes it appear more youthful.

    The Small Bag Located Beneath the Eye — Jellyroll

    The term jellyroll refers to a bulge that develops just beneath the eye. This bulge is only apparent when an individual smiles, squints or laughs. These bulges may cause an individual to look exhausted or make his or her eyes appear puffy. By injecting a small amount of a neuromodulator just beneath the lower lash line, the puffiness beneath the eye subsides. In addition, this area appears softer. These improved eye characteristics help the patient look more alert.

    The Lips — A Lip Flip

    The goal of the lip flip injection session is to relax the orbicularis oris muscle, which is the muscle that surrounds the lips. By relaxing this muscle, the inside portion of the upper lip flips upward and out.

    During a lip flip injection session, Dr. Gabriele Miotto injects Botox Cosmetic into the Cupid’s bow of the upper lip. The term Cupid’s bow refers to the two distinct points in the center of the upper lip. Dr. Miotto also injects the purified neurotoxin protein into the corners of the mouth. Once this muscle relaxes completely, which can take up to five days, the patient’s lips appear fuller.

    The Lips — A Gummy-Looking Smile Resulting from Hyperactive Lip Muscles

    Sometimes Dr. Miotto can reduce a gummy-looking smile with neuromodulator injections. When she is addressing a gummy smile, Dr. Gabriele Miotto injects the purified neurotoxin protein into the muscle beneath the nose and on either side of the patient’s mouth. These injections cause the muscles of the face to relax, which makes it possible for the lips to cover up the patient’s overly exposed gingival tissue. Thus, providing the patient with an aesthetically pleasing smile.

    The Chin — Mentalis Muscle Dysfunction Resulting in Chin Dimples (aka Chin Dents, Pebbled Chin, Pebble-Stone Chin and Orange-Peel Chin)

    The mentalis muscle refers to the pair of chin muscles that are located at its tip. If chin dimples develop, Dr. Miotto can relieve this problem by injecting BOTOX into the mentalis muscle. Chin dimples develop when the muscles of the chin flex excessively.

    The Neck — Horizontal Neck Lines (aka Text Neck)

    As we age; horizontal creases naturally form on the neck. In addition, repeatedly looking down (e.g., while texting) can cause horizontal bands to form prematurely. Dr. Miotto reduces these horizontal lines in the neck by injecting BOTOX Cosmetic above and below the wrinkles. She can also use a combination of dermal filler and neuromodulator injections to address these neck lines.

    The Neck — Vertical Platysma Bands on the Neck

    Platysma bands develop when the neck’s platysma muscle starts hanging vertically (i.e., turkey neck). BOTOX injections for the treatment of the vertical platysma bands are ideal for individuals who are in the early stages of platysmal neck sagging. In addition, athletes who have muscle bulges that develop while grimacing or excessively moving the neck may benefit from neuromodulator injections. Dr. Miotto injects the purified neurotoxin protein into targeted areas of the platysma muscle in the neck. Neuromodulator injections weaken the platysma muscle and lift the neck upwards.

    What Are the Differences Between Neuromodulators and Dermal Fillers?


    As an experienced plastic surgeon and expert injector, Dr. Miotto knows which muscles are causing the lines and wrinkles that are visible on her patient’s face. As she injects the BOTOX into a targeted muscle, it essentially begins freezing the muscle. Once the patient’s muscle relaxes completely (full relaxation can take up to five days), he or she enjoys a rejuvenated appearance.

    Dermal Fillers

    Dermal fillers are gels that Dr. Miotto uses to physically fill in her patients’ wrinkles (e.g., marionette lines). She also uses dermal fillers to add volume to areas of the face that look hollow (e.g., the cheeks and temples).

    What Do Dermal Fillers Consist Of?

    Although dermal filler ingredients vary, fillers consisting of hyaluronic acid (HA) are a popular option. Today, most of the dermal fillers already contain lidocaine, which is the same type of anesthetic used in dental offices.

    Why Choosing an Experienced Expert Injector is Vital

    Whether an individual is having BOTOX or dermal filler injections, choosing an expert injector with experience is the key to obtaining excellent results.

    While administering a purified neurotoxin protein, an expert injector knows the ideal injection location and how deep to insert the needle.

    Since the density, texture and injection depth of dermal fillers vary, choosing an experienced expert injector to perform dermal filler injections is vital. For example, an experienced expert injector knows that to address deep lines and wrinkles (e.g., the nasolabial folds) he or she needs to inject one of the thicker dermal fillers deep into the dermis or the subcutaneous layer. However, when using a dermal filler to add volume to the lips, Dr. Miotto injects a thinner filler into the submucosal layer of the lip.

    Knowing the characteristics and injection depth of each dermal filler is essential to providing the patient with optimal results.

    A Combination Neuromodulator and Dermal Filler Injection Session in Atlanta

    Sometimes, Dr. Miotto’s patients ask her to address several areas of the face during a single treatment session. These patients may be good candidates for a combination neuromodulator and dermal filler treatment.

    Reasons Individuals Visit Atlanta to Have Dr. Gabriele Miotto Administer Their Injections

    Dr. Miotto is an Experienced Plastic Surgeon

    As an experienced plastic surgeon, Dr. Miotto knows and understands the anatomy of the face, which allows her to quickly and easily determine which muscles are contracting. These are the muscles Dr. Gabriele Miotto targets while administering the purified neurotoxin protein via injection.

    Dr. Gabriele Miotto is Also an Expert Injector

    Since Dr. Miotto is also an experienced expert injector, she has an excellent injection technique, which helps her patients feel comfortable during their BOTOX Cosmetic treatment at ME Plastic Surgery in Atlanta.

    The First Visit with Dr. Gabriele Miotto: What Patients Can Expect

    During the first visit, Dr. Gabriele Miotto examines the patient’s face to determine whether he or she is a good candidate for BOTOX injections. Patients with chronic conditions as well as those who have allergies to latex or lidocaine need to inform Dr. Miotto of these issues during this first consultation.

    Dr. Miotto also needs to review the patient’s medical history before she administers any injections. A thorough outline of the patient’s medical history is important because there are conditions and medications that can jeopardize the patient’s safety during treatment and negatively affect the treatment outcome. For example, patients taking prescription blood thinners and those who have been taking non-steroidal anti-inflammatory drugs (NSAIDs) are likely to experience more bruising than patients who have not.

    If Dr. Miotto is aware that her patient is taking NSAIDs, she can provide a recommendation for other over-the-counter medications that do not cause unwanted side effects.

    If a patient is taking prescription blood thinners, Dr. Miotto may request that he or she speaks with the prescribing physician about potentially decreasing the dose or discontinuing the medication for several days prior to the BOTOX injection treatment.

    Patients Must Speak with Their Physician Before Discontinuing or Reducing the Dose of Prescription Medications

    It is important that patients who take prescription medication continue taking their medication until they speak with their physician. Abruptly stopping a medication for any reason can be dangerous.

    A Purified Neurotoxin Protein Injection Session with Dr. Gabriele Miotto at ME Plastic Surgery

    A neuromodulator treatment session in Atlanta is relatively short. This treatment typically lasts from just 10 minutes to half an hour.

    The Steps of a BOTOX Cosmetic Injection Session in Atlanta:

    1. First, Dr. Gabriele Miotto cleans the patient’s face.
    2. Next, she applies a topical anesthetic to the treatment areas. This anesthetic numbs the areas where Dr. Miotto is injecting the purified neurotoxin protein.
    3. Using a very fine needle, Dr. Miotto injects a small amount of BOTOX into one of the muscles responsible for creating dynamic wrinkles.

    Many of Dr. Gabriele Miotto’s patients return to ME Plastic Surgery regularly for refresher treatments. By scheduling these treatments in advance, patients consistently have the refreshed, rejuvenated appearance they desire.

    How Much Do Purified Neurotoxin Protein Injections in Atlanta Cost?

    Since each patient is unique, Dr. Miotto needs to examine an individual before she can provide information about his or her treatment costs.

    Potential Risks of Purified Neurotoxin Protein Injections

    All treatments have risks, including neuromodulator injections.

    Potential risks include:

    • Nausea.
    • A headache
    • Pain, inflammation or bruising at the injection site.
    • Flu-like symptoms.
    • Undesirable results.
    • Temporary facial drooping or weakness.
    • Redness.

    If an expert injector administers the neuromodulator injections, the likelihood of the botulinum toxin type A migrating to another part of the face is unlikely. Nonetheless, in the event that it does, botulism-like symptoms may result.

    These symptoms can include:

    • Difficulty breathing.
    • Slurred speech.
    • Muscle weakness.
    • Trouble swallowing.

    As an experienced plastic surgeon and expert injector in Atlanta, Dr. Gabriele Miotto provides her BOTOX® Cosmetic patients with subtle, natural-looking results. If you are considering any type of facial rejuvenation treatment, and you reside in, or will be visiting, the Atlanta area, contact Dr. Miotto’s office at (404)850-5851 to schedule a consultation. The address for ME Plastic Surgery is 3200 Downwood Circle Northwest. We are in Suite 640.



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